Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 4672
Country/Region: Namibia
Year: 2007
Main Partner: Pact, Inc.
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: USAID
Total Funding: $464,507

Funding for Care: Adult Care and Support (HBHC): $293,373

The African Palliative Care Association (APCA) is dedicated to applying lessons learned from other African countries to scale-up of cost-effective, culturally-appropriate palliative care for PLWHA & their families. This activity is continuing from FY06 & relates to MoHSS (MoHSS/CDC Activity #7331), PACT Community Reach (Activity #7412), Comforce (Activity #8024), (IAP Basic Care Activity #8014) & the DAPP roll-out of CBHC (Activity #7326).

Palliative care technical expertise in Namibia is currently limited to oncologists & other health workers in the Government Cancer hospital. Hospices found throughout many parts Africa largely focused on end of life care (especially prior to ART) & who often provide broader technical support to PEPFAR investments to advance comprehensive HIV-related palliative care do not exist in Namibia; this has greatly limited the development & expansion of HIV-related palliative care. In FY06, the USG & its partners, including the MoHSS began receiving technical assistance from APCA members, a pan-African network of African palliative care technical support, including support for the Catholic AIDS Action (CAS) community & home-based care (CHBC) program to integrate key palliative care strategies & palliative care training into their CHBC efforts within the Northern region of Namibia; sensitization of MoHSS, key stakeholders & USG partners care & treatment partners regarding the palliative approach to HIV/AIDS care & effective bi-directional referrals; review of the adapted IMAI palliative care module; & technical support to the MoHSS & other in-country stakeholders to mobilize for Namibian leadership in palliative care training, service delivery & policy development.

While significant program accomplishments are underway, continued technical support is needed to build on program successes, address existing gaps & develop in-country expertise dedicated to advancing palliative care. In FY07, it is anticipated that APCA will support the MoHSS, USG partners & other stakeholders with technical support for the new MoHSS IMAI technical advisor (Comforce/CDC Activity #8024) & MoHSS Coordinator for Palliative Care & OI Services in the MoHSS Directorate of Special Programs (MoHSS/CDC Activity #7331) for roll-out of HIV-related palliative care services, including support for the national Integrated Management of Adult Illnesses (IMAI) palliative care program. MoHSS leadership & implementation for facility-based palliative care for adult PLHWA is within the framework of the IMAI program. Anticipated in 2007, the 13 regions will be responsible for the rollout of IMAI, including the palliative care module, to selected health centers & clinics in their catchment area. APCA will support the MoHSS & ITECH (Activity #7349) with implementation of IMAI palliative module through ongoing review of palliative care training materials & essential drug lists for palliative care provision, & technical assistance with regards to the current policy environment for ensuring availability & accessibility of essential palliative care drugs. It is anticipated that roll-out of IMAI will likely result in MOHSS development of a national palliative care policy that allows nurses to prescribe narcotics & symptom-relieving medications; technical support from APCA, with technical experience in nurse prescription of narcotics in Zimbabwe & Uganda, will be essential to supporting this activity. Building on successes to date with the 2006 APCA Regional Drug Availability Workshop in Entebbe, APCA will work with Namibian stakeholders to ensure Namibian participation & outcomes in a regional drug availability workshop for countries within the Southern Africa Region. The objective of including Namibia in this workshop will be to improve the availability, knowledge & appropriate use of medications for effective symptom & pain management for PLWHA at facility & community levels of care (for both PLWHA on ART & not on ART). A small team of key stakeholders including the MoHSS engaged in the IMAI program will participate in the workshop & then develop a strategic plan with regards to how to ensure & promote drug availability & accessibility within the IMAI program in Namibia.

With the development of palliative care services within country, the gradual understanding of what palliative care involves & its integration into the existing health structures it is anticipated that a national working-group of key Namibian stakeholders will be formed within FY06. Within FY07 APCA will support this national working group & the MoHSS to develop a detailed plan for palliative care leadership & integration at policy, service delivery & education/training levels in Namibia, including a response to the MoHSS request to support a palliative care needs assessment which will better inform program planning & strategic leadership on palliative care for PLWHA. APCA will also support exchange visits for Namibia MoHSS staff & select PEPFAR community care partners to learn from Ugandan experiences in implementation of palliative care at facility & community levels, &

understand the resources & commitment required to advance palliative care in Namibia.

APCA will provide ongoing support in FY07 to CAA (PACT Activity #8043) to expand the palliative care service delivery pilot to additional sites which are to be determined in partnership with the MoHSS & CAA. APCA will also partner with the MoHSS to integrate key palliative care strategies in the Omaheke Health Education Program (OHEP), a program cited as a best practice in the delivery of quality community & home based care in Namibia. This will include strengthening the delivery of a multidisciplinary approach to family-centered care, pain & symptom management, effective bi-directional referrals, improved bereavement & communication skills, & increased training to support delivery of key aspects of the program. The OHEP model is currently a training site for other HIV/AIDS programs & the integration of key palliative care strategies will allow this site to expand the current knowledge & training base on palliative care for health providers in Namibia. APCA will train 20 health care professionals to receive TOT in palliative care, & also directly train Omaheke & CAA volunteers. APCA will ensure gender-sensitive approaches, including equitable training & support of male & female health care workers with the goal of equitable access to HIV/AIDS services for PWLWHA & their families throughout USG-supported programs.

Other PEPFAR support for APCA is incorporated in (PACT/APCA TE Activity #8022) to provide technical support in carrying out a program evaluation utilizing the APCA African Patient Outcomes Scale (POS) as part of the evaluation protocol in partnership with King's College in London. It is anticipated that this evaluation will utilize & adapt lessons learned from the centrally-funded PEPFAR targeted evaluation to inform programming & evaluate models which are specific to the Namibian context.

Support will be provided to APCA by the Regional Palliative Care Advisor from the USAID Regional HIV/AIDS Program in Southern Africa (IAPWS Activity #8014).

Funding for Strategic Information (HVSI): $171,134

The USG supports a tremendous range of palliative care activities in Namibia. Some palliative care is provided by partners and subpartners under the "palliative care" program areas; other palliative care is provided by partners in other program areas, such as prevention, counseling and testing, and HIV treatment. Care-related activities extend from clinical interventions focused on the patient (e.g. infection prophylaxis and pain management) to psychological, spiritual and social care interventions for the patient and the patient's family. Because the PEPFAR definition of palliative care is broad and many partners working in other program areas are also providing palliative care, more information is needed on the range, levels and quality of activities being supported. In FY 07, APCA will conduct an initial assessment of these activities and develop tools that can be used for ongoing monitoring and evaluation of palliative care in Namibia. This activity will be undertaken in consultation with USG-supported palliative care partners, including the Ministry of Health and Social Services (MoHSS), which has also expressed the need for better information about all forms of palliative care provision.

USG/Namibia will use PEPFAR funds to develop: 1) an inventory of PEPFAR-supported palliative care activities in Namibia; 2) a practical framework for categorizing these activities including the levels of palliative care provided; 3) a set of process indicators that can be used to evaluate the quantity, quality and levels of palliative care provided; 4) a model that estimates the demand for and supply of palliative care by select PEPFAR-supported palliative care partners in a specified geographic area including an appraisal on implementation of elements of the preventive care package, and strategies that support treatment adherence and management of symptoms and pain; and 5) application of "lessons learned" from the centrally-funded PEPFAR targeted evaluation which is implemented by MEASURE Evaluation, King's College London, the African Palliative Care Association (APCA) and the USG Palliative Care Technical Workgroup. Results will be used to inform program planning by the USG/NAMIBIA team and Namibian Government, expand palliative care service delivery in under-served areas, and identify priorities for monitoring and evaluation.

Subpartners Total: $450,164
African Palliative Care Association: $450,164